Binglan Zhang

Matched-pair comparisons of stereotactic body radiotherapy (SBRT) versus surgery for the treatment of early stage non-small cell lung cancer: A systematic review and meta-analysis

PURPOSE A population-based matched-pair comparison was performed to compare the efficacy of stereotactic body radiotherapy (SBRT) versus surgery for early-stage non-small cell lung cancer (NSCLC). METHODS All the eligible studies were searched by PubMed, Medline, Embase, and the Cochrane Library. The meta-analysis was performed to compare odds ratios (OR) for overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), local control (LC), and distant control (DC). RESULTS Six studies containing 864 matched patients were included in the meta-analysis. The surgery was associated with a better long-term OS in patients with early-stage NSCLC. The pooled OR and 95% confidence interval (CI) for 1-year, 3-year OS were 1.31 [0.90, 1.91] and 1.82 [1.38, 2.40], respectively. However, the difference in 1-year and 3-year CSS, DFS, LC and DC was not significant. CONCLUSIONS This systematic review found a superior 3-year OS after surgery compared with SBRT, which supports the need to compare both treatments in large prospective, randomized, controlled clinical trials.

Shear Wave Elastography for Differentiation of Benign and Malignant Thyroid Nodules A Meta-analysis

The purpose of this study was to assess the performance of shear wave elastography for identification of benign and malignant thyroid nodules using meta‐analysis.

Prognostic Role of MicroRNA-210 in Various Carcinomas: A Systematic Review and Meta-Analysis

Objective. Many studies have shown that microRNAs (miRNAs) could play a potential role as prognostic biomarkers of tumors. The aim of this study is to summarize the global predicting role of microRNA-210 (miR-210) for survival in patients with a variety of carcinomas. Methods. Relevant literature was identified using PubMed and the information in eligible studies has been extracted. Then meta-analysis of hazard ratio (HR) was performed to evaluate the prognostic role of the miR-210 in different tumors. Results. This meta-analysis included 9 published studies dealing with various carcinomas. For recurrence free survival or disease free survival (RFS/DFS), the combined hazard ratio (HR) and 95% confidence interval (95% CI) of higher miR-210 expression were 2.47 [1.36, 4.46], which could significantly predict poor survival in general carcinomas. MicroRNA-210 was also a significant predictor for overall survival (OS), metastasis free survival or distant relapse free survival (MFS/DRFS), and disease specific survival (DSS). Importantly, subgroup analysis suggested that higher expression of miR-210 correlated with worse RFS/DFS, OS, and MFS/DRFS, especially in breast cancer, which were 3.36 [2.30, 4.93], 3.29 [1.65, 6.58], and 2.85 [1.76, 4.62] separately. Conclusion. Our studies suggested that microRNA-210 could predict the outcome of patients with varieties of tumors, especially in breast cancers.

Intensity-modulated radiation therapy versus 2D-RT or 3D-CRT for the treatment of nasopharyngeal carcinoma: A systematic review and meta-analysis.

OBJECTIVE To compare clinical treatment outcomes and late toxicities of intensity-modulated radiation therapy (IMRT) with those obtained with two-dimensional radiation therapy (2D-RT) or three-dimensional conformal radiation therapy (3D-CRT) in nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS We searched all the eligible studies from the Cochrane Library, PubMed, Medline, and Embase. The meta-analysis was performed to compare odds ratio (OR) for overall survival (OS), tumor local control (LC), and late toxicities. RESULTS A total of eight studies met the criteria to perform a meta-analysis including 3570 participants, with 1541 patients in the IMRT group and 2029 in the 2D-RT or 3D-CRT group. The IMRT group was associated with a better 5-year overall survival (OR=1.51; 95% confidence interval (CI) 1.23-1.87; p=0.0001), and tumor local control (LC) (OR=1.94; 95% CI 1.53-2.46; p<0.00001). According to CTCAE v3.0 (Common Terminology Criteria for Adverse Events) and RTOG/EORTC (Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer), the incidence of late xerostomia in those who received IMRT was significantly lower than that of the control group (OR=0.18; 95% CI, 0.07-0.46; p=0.0004). In addition, the radiation-induced chronic toxicities rate of trismus and temporal lobe neuropathy (TLN) were also significantly lower in the IMRT group than in the control group (OR=0.18; 95% CI 0.04-0.83; p=0.03; OR=0.44; 95% CI 0.28-0.69; p=0.0003, respectively). CONCLUSIONS This systematic review and meta-analysis demonstrated that IMRT mayobtain a better antitumor effect, and significantly decrease the incidence of radiation-induced late toxicities in patients with NPC.

Real-time elastography in the diagnosis of patients suspected of having prostate cancer: a meta-analysis.

The goal of the study described here was to assess the performance of real-time elastography (RTE) in the detection of prostate cancers using a meta-analysis. A literature search of PubMed, Medline, Embase and the Cochrane Library was conducted. Published studies that evaluated the diagnostic performance of RTE in the diagnosis of prostate cancer and using the histopathology of the radical prostatectomy specimen as a reference standard were included. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the curve were calculated to examine the accuracy of RTE. A total of seven studies that included 508 patients were analyzed. The pooled sensitivity and specificity for the diagnosis of prostate cancer by RTE were 0.72 (95% confidence interval: 0.70-0.74) and 0.76 (0.74-0.78), respectively. The summary diagnostic odds ratio was 12.59 (7.26-21.84), and the area under the curve was 0.841 (Q* = 0.773). In conclusion, RTE imaging has high accuracy in the detection of prostate cancers using the histopathology of the radical prostatectomy specimen as the reference standard and may reduce the number of core biopsies in the future.

Targeting of cancer‑associated fibroblasts enhances the efficacy of cancer chemotherapy by regulating the tumor microenvironment

Cancer-associated fibroblasts (CAFs), key components of the tumor stroma, can regulate tumorigenesis by altering the tumor microenvironment in variety of ways to promote angiogenesis, recruit inflammatory immune cells and remodel the extracellular matrix. Using a murine xenograft model of colon carcinoma, the present study observed that oxaliplatin increased the accumulation of CAFs and stimulated the production of cytokines associated with CAFs. When oxaliplatin was combined with the small-molecule dipeptidyl peptidase inhibitor PT-100, which inhibits CAFs by targeting fibroblast activation protein (FAP), the accumulation of CAFs was markedly reduced, xenograft tumor growth was significantly suppressed and the survival of the mice increased, compared to those of mice treated with oxaliplatin or PT-100 alone. Furthermore, the xenograft tumor tissues of mice treated with oxaliplatin and PT-100 contained lower numbers of tumor-associated macrophages and dendritic cells, expressed lower levels of cytokines associated with CAFs and had a lower density of CD31+ endothelial cells. The present study demonstrated that pharmacological inhibition of CAFs improved the response to chemotherapy, reduced the recruitment of immune tumor-promoting cells and inhibited angiogenesis. Combining chemotherapy with agents which target CAFs may represent a novel strategy for improving the efficacy of chemotherapy and reducing chemoresistance.

Pretreatment Thrombocytosis as a Prognostic Factor in Women with Gynecologic Malignancies: a Meta-analysis

BACKGROUND This study was performed to analyze the prognostic implications of pretreatment or preoperative thrombocytosis in women with gynecologic malignancies. MATERIAL AND METHODS We surveyed 2 medical databases, PubMed and EMBASE, to identified all relevant studies. A total of 14 (n=3,490) that evaluated the link between thrombocytosis and 5-year survival were included. REVMAN version 5.1 was used for our analysis and publication bias was evaluated using the Beggs funnel plot and tested by STATA 11.0. Risk ratios (RRs) with 95% confidence intervals (CIs) generated by the random effect model were used to assess the strength of any association. RESULTS 709(20.3%) of the 3,490 patients exhibited thrombocytosis (platelet counts >400?109/L) at primary diagnosis, and their mortality was 1.62-fold higher compared with the others (RR=1.62, 95%CI= [1.28- 2.05], p<0.0001). Thrombocytosis failed to have a stronger effect on the survival of advanced patients of stages III to IV in our study (n=478, RR=1.29, 95% CI= [1.13-1.48], p=0.0003), nor in women with cervical cancer in stage IB (n=1371, RR= 1.73, 95% CI= [1.71-2.58], p=0.007). In addition, when adjusted for different carcinoma, it was associated with worse prognosis for all except the ones with vulvar cancer (n=201, RR= 0.43, 95% CI= [0.14-1.29], p=0.13). CONCLUSIONS This meta-analysis indicated that thrombocytosis might be associated with a worse prognosis for patients with gynecologic malignancies but without specificity or sensitivity for the ones in advanced stage. When adjusted for different gynecologic malignancies, it showed a significant effect on survival of all except vulvar cancers.

3D conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

AIM To compare transcatheter arterial chemoembolization (TACE) and 3D conformal radiotherapy (3D-CRT) with TACE monotherapy in hepatocellular carcinoma (HCC). METHODS We searched all the eligible studies from the Cochrane Library, PubMed, Medline, Embase, and CNKI. The meta-analysis was performed to assess the survival benefit, tumor response, and the decline in α-fetoprotein (AFP) level. According to the heterogeneity of the studies, pooled OR with 95%CI were calculated using the fixed-effects or random-effects model. An observed OR > 1 indicated that the addition of 3D-CRT to TACE offered survival benefits to patients that could be considered statistically significant. Statistical analyses were performed using Review Manager Software. RESULTS Ten studies met the criteria to perform a meta-analysis including 908 HCC participants, with 400 patients in the TACE/3D-CRT combination group and 508 in the TACE alone group. TACE combined with 3D-CRT significantly improved 1-, 2- and 3-year overall survival compared with TACE monotherapy (OR = 1.87, 95%CI: 1.37-2.55, P < 0.0001), (OR = 2.38, 95%CI: 1.78-3.17, P < 0.00001) and (OR = 2.97, 95%CI: 2.10-4.21, P < 0.00001). In addition, TACE plus 3D-CRT was associated with a higher tumor response (complete remission and partial remission) (OR = 3.81; 95%CI: 2.70-5.37; P < 0.00001), and decline rates of AFP level (OR = 3.24, 95%CI: 2.09-5.02, P < 0.00001). CONCLUSION This meta-analysis demonstrated that TACE combined with 3D-CRT was better than TACE monotherapy for patients with HCC, which needs to be confirmed by large multicenter trials．

Hurdles of CAR-T cell-based cancer immunotherapy directed against solid tumors

Recent reports on the impressive efficacy of chimeric antigen receptor (CAR)-modified T cells against hematologic malignancies have inspired oncologists to extend these efforts for the treatment of solid tumors. Clinical trials of CAR-T-based cancer immunotherapy for solid tumors showed that the efficacies are not as remarkable as in the case of hematologic malignancies. There are several challenges that researchers must face when treating solid cancers with CAR-T cells, these include choosing an ideal target, promoting efficient trafficking and infiltration, overcoming the immunosuppressive microenvironment, and avoiding associated toxicity. In this review, we discuss the obstacles imposed by solid tumors on CAR-T cell-based immunotherapy and strategies adopted to improve the therapeutic potential of this approach. Continued investigations are necessary to improve therapeutic outcomes and decrease the adverse effects of CAR-T cell therapy in patients with solid malignancies in the future.

Contrast-enhanced sonography for the identification of benign and malignant thyroid nodules: Systematic review and meta-analysis.

The use of contrast‐enhanced sonography (CEUS) has yielded promising results in the differentiation of thyroid nodules. We conducted this meta‐analysis to assess its performance in identifying and distinguishing between benign and malignant thyroid nodules.